Tick-borne encephalitis


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What is tick-borne encephalitis?

Tick-borne encephalitis (TBE) is a disease caused by a flavivirus that affects the central nervous system. It is transmitted through the bite of an infected tick. There are three sub-types: European or Western TBE virus, Siberian TBE virus, and Far Eastern TBE virus.

What is my risk?

The risk is low for most travellers staying in urban areas and who do not consume unpasteurized dairy products.

The risk is greater for travellers going to risk areas and:

  • Participating in outdoor activities during tick season (April to November) including walking, cycling, camping, or working in grasslands, meadows, low-growing dense bush, low ground cover, wooded or forested areas.
  • Eating or drinking unpasteurized milk or milk products.

How is it transmitted?

  • TBE is transmitted through the bite of an infected tick, primarily of the Ixodes ricinus and Ixodes persulcatus species.
  • Ticks generally bite from April to November with peak biting activity in early and late summer.
  • Tick bites are painless and often not noticed.
  • TBE can also be transmitted through contaminated unpasteurized cow, sheep or goat milk and milk products obtained from infected animals.

What are the symptoms?

  • Symptoms usually take 4 to 28 days to appear, although the majority of infected people show no symptoms.
  • They usually appear faster (within three to four days) if the disease is transmitted through milk or milk products
  • There are often two phases:
    • In the first phase, which usually lasts for one to eight days, symptoms are flu-like and include fever, fatigue, headaches, muscle aches, loss of appetite, nausea and vomiting.
    • In the second phase, the central nervous system is affected and symptoms can include encephalitis (swelling of the brain), confusion, paralysis, meningitis (swelling of the membrane around the brain and spinal cord), and/or myelitis (swelling of the spinal cord).
  • In more severe cases, complications during the second phase may cause long-term neurological damage (for example, memory loss, hearing impairment, loss of coordination) or even death.
  • The severity of the illness increases with age.

Can tick-borne encephalitis be treated?

There is no specific treatment for TBE, only supportive care to help relieve symptoms.

Where is tick-borne encephalitis a concern?

TBE is found across Europe and Asia, from eastern France to Northern China and Japan and from northern Russia to Albania. Consult the map of areas of risk for more details. Ticks that spread TBE can be found in forests, wooded parks, grasslands, meadows, low-growing dense bush and low ground cover.

Recommendations

Consult a health care provider or visit a travel health clinic preferably six weeks before you travel.

  1. Protect yourself against tick bites.
    • Remember to cover up!
    • Wear long sleeves, tuck in shirts, tuck pants into socks and wear closed shoes when participating in outdoor activities in risk areas.
    • Use insect repellent (bug spray) on exposed skin and wear permethrin-treated clothes.
    • Avoid wooded, high grass or brushy areas. It is best to stay on designated hiking trails.
  2. Follow personal protective measures during and after high-risk activities:
    • Check your skin and clothes for ticks:
      • Common areas to find ticks include the hairline, behind the ears, on elbows, legs, the groin and/or armpits.
      • An adult tick that has finished feeding may be as large as a coffee bean. Immature ticks are considerably smaller.
    • Carefully remove any ticks you find:
      • Use fine-tipped tweezers to remove ticks.
      • Grasp the tick as close to the skin as possible and pull steadily upwards without twisting or jerking. This increases your chances of removing all of the tick.
      • Do not use alcohol, matches or petroleum jelly (i.e. Vaseline®) to remove ticks. 
      • Avoid handling ticks with your bare hands.
      • Disinfect the bite site after you remove the tick. Wash your hands with soap and water.
      • Document the date of the tick bite and the start of any symptoms, if they appear.
      • If any symptoms occur within 28 days of the tick bite, see a health care provider immediately.
  1. A vaccine against tick-borne encephalitis does exist but is only available in countries where tick borne encephalitis is present
    • Travellers at high risk can consult a health care provider at their destination to discuss the benefits of getting vaccinated.
  2. Avoid unpasteurized milk and milk products.
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